Suture trimmer

ABSTRACT

A suture trimmer having a shaft with a groove formed in the side thereof, a cutting member movably disposed within the shaft, and a suture retainer slidably disposed within the shaft. The suture trimmer may be used to position knots formed within a suture loop prior to trimming the free end(s) of the suture loop, and to deliver an agent near the location where the suture is severed.

RELATED APPLICATIONS

[0001] The present application is a continuation-in-part of pending U.S.patent application Ser. No. 10/004,817, filed Dec. 7, 2001, and is alsoa continuation-in-part of pending U.S. patent application Ser. No.10/027,681, filed Dec. 21, 2001, the complete disclosures of which areincorporated herein by reference in their entirety.

FIELD OF THE INVENTION

[0002] The present invention relates generally to surgical devices andmethods. More particularly, the present invention relates to theconstruction and use of devices for advancing surgical knot(s) andtrimming the ends of the suture adjacent to the knot(s). Such a deviceis to be referred to as a “suture trimmer”, as used through the appendedspecification.

BACKGROUND OF THE INVENTION

[0003] The closing of incisions and wounds using suture is a preferredtechnique of surgeons and many other physicians. While other techniquesare now available such as stapling, the use of “tissue glues,” and theuse of collagen for closing vascular punctures, the use of suture isoften preferred because it provides a reliable and tight closure of anywound. Additionally, if a suture is to fail, the surgeon will knowimmediately. In contrast, many of the other devices listed above whichmay not fail until some time after the procedure.

[0004] While the suturing of a wound is a relatively straight-forwardprocedure in most open surgical procedures, placement and tying ofsutures in laprascopic and other minimally invasive procedures can beproblematic. In order to provide for suturing under such circumstances,a variety of devices have been developed for the remote placement andtying of suture through cannulas under video observation. Usually, asliding knot will be formed in a suture loop, a tool known as a “knotpusher” such as that shown in U.S. Pat. No. 5,797,929 the entirety ofwhich is hereby incorporated by reference, is utilized to advance andposition the knot and tighten the loop of suture.

[0005] Such knot pushing devices may also be utilized in recentlydeveloped techniques for the remote suturing of vascular punctures.Punctures may be formed in the femoral or other arteries to providevascular access for performing angioplasty and other vascularprocedures. Such techniques are described in U.S. Pat. Nos. 5,417,699;5,527,322 and 6,136,010 the entirety of which are hereby incorporated byreference. Such methods result in the placement of a suture loop throughtissue on opposite sides of the vascular puncture. Two free ends of thesuture loop are brought out through a tissue tract leading to thepuncture, and the ends may be externally tied by the treating physician.Alternatively, a knot forming device such as that shown in U.S. Pat. No.6,171,317, the entirety of which is hereby incorporated by reference,may be utilized to tie a knot.

[0006] Through the use of a knot pusher, such as that shown anddescribed in U.S. Pat. No. 5,797,929 the knot may be advanced throughthe tissue tract so that it lies directly over the adventitial wall ofthe blood vessel.

[0007] After the knot has been advanced over the adventitial wall of theblood vessel and tightened, the excess suture must be cut away.Typically, a surgeon may utilize a scalpel or a pair of scissors to cutthe suture ends just below the exterior surface of the patient's skin.

[0008] A concern with this method is that by leaving lengths of suturewithin the wound may lead to irritation of the incision. Moresignificantly, a relatively long suture end, extending from the knot atthe vessel repair to the skin level, may act as a “wick” for infectivemicroorganisms which may be present at skin level. The wick wouldprovide a conduit for these microorganisms to travel from the skinsurface to the vessel repair, thereby leading to infection. Many times asurgeon cannot easily shorten this cut length because the location ofthe knot is well below the patient's tissue and is not readily visible,therefore they can only shorten the suture to the point that they canvisually see. Further still, many surgical procedures are moving awayfrom being open and toward being minimally invasive wherein theprocedure is performed within a small opening formed in the patient'stissue. As described above, many times the surgeon cannot see the vesselwhich they are trying to close with the suture.

[0009] Therefore there is a need for a device that will enable a surgeonto advance a knot and trim the excess suture from the knot withouthaving to visually see the knot.

SUMMARY OF THE INVENTION

[0010] In accordance with the present invention there is provided asuture trimmer, the suture trimmer including a shaft having a proximalend and a distal end and an axis therebetween, the shaft having a slotformed in the side thereof, the slot in communication with an openingformed in the side of the shaft, the opening disposed proximal thedistal end. In various embodiments, the suture trimmer may preferablyinclude a cutting member that is slidably disposed within the shaft, anda suture retainer movably disposed within the shaft. As will beexplained, the suture retainer may either be slidably or rotatabledisposed within the shaft. Preferably, the suture retainer is disposedwithin the bore of the cutting member, but the present invention is notso limited.

[0011] In alternative embodiments, the cutting member may either bemoved in a distal or proximal direction within the shaft of the suturetrimmer to cut the suture(s).

[0012] In alternative embodiments, the suture is positioned within thegroove and opening in the side of the shaft by either first moving thesuture retainer in a proximal direction within the shaft or by rotatingthe suture retainer within the shaft.

[0013] In optional embodiments, the present invention is further adaptedto dispense an agent at a location near or adjacent to where the sutureis severed (for example, at or near the distal end of the shaft). Suchagent may comprise an antibacterial or anti-infectant agent or acoagulant, but the present invention is not so limited. Rather, anysuitable therapeutic agent may be dispensed by the present invention.Various systems for dispensing the agent may include, for example, alumen passing through the device, an agent storage chamber on or withinthe device, or a removable agent storage cartridge received into thedevice.

[0014] Various exemplary structures or methods for cutting suture mayinclude: (1) cutting the suture between the distal end of the cuttingmember and an anvil portion of the suture retainer; or (2) cuttingsuture between the distal end of the cutting member and a proximal endor flat face of a fitting received in the distal end of the shaft.

[0015] In accordance with another aspect of the present invention thereis provided a method for trimming suture, the method including the stepsof disposing a free end of suture through a groove and opening formed ina distal end of a suture trimmer, wherein a cutting member is actuatedwithin the suture trimmer, the cutting member configured to sever thesuture disposed in the opening. Preferably, such suture comprises asuture loop including at least one knot and at least one free end ofsuture. In one exemplary application, the method is performed by placingthe suture loop through a wall of a patient's femoral artery, cuttingthe suture in a tissue tract adjacent to the femoral artery, anddelivering an agent to the tissue tract in the vicinity of the loop ofsuture.

BRIEF DESCRIPTION OF THE DRAWINGS

[0016] The objects and advantages of the invention will become apparentfrom the following detailed description of preferred embodiments thereofin connection with the accompanying drawings in which like numeralsdesignate like elements and in which:

[0017]FIG. 1 is a isometric view of an exemplary embodiment of a suturetrimmer in accordance with the present invention;

[0018]FIG. 2 is a partial cut-away isometric view of the suture trimmerin accordance with the present invention;

[0019]FIG. 3A is a partial perspective view of a first embodiment of thecutting member in accordance with the present invention;

[0020]FIG. 3B is a partial perspective view of a second embodiment ofthe cutting member in accordance with the present invention;

[0021]FIG. 4 is a partial perspective view of a first embodiment of thesuture retainer in accordance with the present invention;

[0022]FIG. 5 is a partial isometric view of the distal tip of the suturetrimmer in accordance with the present invention illustrating a sutureloop disposed therethrough and the suture retainer is in a retractedposition;

[0023]FIG. 6 is a partial isometric view of the distal tip of the suturetrimmer in accordance with the present invention illustrating a sutureloop being disposed therethrough wherein the suture retainer is in adeployed (i.e.: distally advanced) position;

[0024]FIG. 7 is a partial isometric view of the distal tip of the suturetrimmer in accordance with the present invention illustrating a sutureloop being disposed therethrough wherein the cutting member as shown inFIGS. 3A and 5 has been moved proximally to sever the suture;

[0025]FIG. 8 is an isometric view of an alternative embodiment of asuture trimmer in accordance with the present invention;

[0026]FIG. 9 is a cross-sectional view of the suture trimmer inaccordance with FIG. 8 illustrating the slider assembly disposed withinthe handle;

[0027]FIG. 10 is a partial view of the distal tip of the suture trimmerin accordance with FIG. 8, wherein a suture loop has been formed in apatient's tissue;

[0028]FIG. 11 is a partial view of the distal tip of the suture trimmerof FIG. 8, wherein the suture retainer has been retracted to provide anopening to receive the suture into the device;

[0029]FIG. 12 is a partial view of the distal tip of the suture trimmerof FIG. 8, wherein the suture retainer has been advanced distally andthen rotated to align the free ends of the suture with the cutting edgeformed in the opening of the shaft of the suture trimmer;

[0030]FIG. 13 is a partial view of the distal tip of the suture trimmerof FIG. 8, wherein the suture retainer has been retracted to cut thesuture against the cutting edge formed in the opening in the side of theshaft;

[0031]FIG. 14 is perspective view of yet another alternative embodimentof a suture trimmer in accordance with the present invention;

[0032]FIG. 15 is a sectional view of the distal tip of the suturetrimmer in accordance with FIG. 14 illustrating the elongated member ina proximal (i.e. retracted) position;

[0033]FIG. 16 is a sectional view of the distal tip of the suturetrimmer in accordance with FIG. 14, wherein the elongated member hasbeen distally advanced to retain at least one suture in the distal tipof the device;

[0034]FIG. 17 is a sectional view of the distal tip of the suturetrimmer in accordance with FIG. 14, wherein the elongated member of thesuture trimmer has been rotated to a cutting position;

[0035]FIG. 18 is a sectional view of the distal tip of the suturetrimmer in accordance with FIG. 14, wherein the elongated member hasbeen moved proximally (i.e. retracted) to trim the suture;

[0036]FIG. 19A is a side elevation view of an embodiment of theinvention using a rotating suture retainer and a push-to-cut cuttingmember, with the suture retainer rotated to a first position to receivea suture into a groove and opening in the device;

[0037]FIG. 19B is a view similar to FIG. 19A, but with the sutureretainer rotated to a second position to trap the suture in the device;

[0038]FIG. 19C is a view similar to FIG. 19B, but with the cuttingmember distally advanced to sever the suture;

[0039]FIG. 19D is a sectional side elevation view corresponding to FIG.19C, further illustrating details of the operation of the system;

[0040]FIG. 20A is a side elevation view of an embodiment of theinvention using a slidable suture retainer and a push-to-cut cuttingmember, with the suture retainer moved distally (i.e. retracted) toreceive a suture into the device;

[0041]FIG. 20B is a view similar to FIG. 20A, but with the sutureretainer moved distally (i.e. advanced) to trap the suture in thedevice;

[0042]FIG. 20C is a view similar to FIG. 20B, but with the cuttingmember moved distally to sever the suture;

[0043]FIG. 20D is a sectional side elevation view corresponding to FIG.20C, further illustrating details of the operation of the system;

[0044]FIG. 21 is a schematic sectional side elevation view of anembodiment of the invention configured to dispense an agent at or nearthe location where the suture is severed;

[0045]FIG. 22 is a schematic sectional side elevation view of analternate embodiment of the invention configured to dispense an agent ator near the location where the suture is severed;

[0046]FIG. 23A is an enlarged view of a portion of the device shown inFIG. 22 prior to dispensing the agent;

[0047]FIG. 23B is an enlarged view of a portion of the device shown inFIG. 22 after the agent has been dispensed;

[0048]FIG. 24 is a view similar to FIG. 23A, but wherein a removablecartridge filled with the agent is instead inserted into the device;

[0049]FIG. 25 is a side elevation view of an embodiment of the cuttingmember including optional force absorbing features;

[0050]FIG. 26 is a sectional side elevation view of an embodiment of theinvention having an annular shaped agent chamber, an annular shapedplunger and an annular shaped bushing;

[0051]FIG. 27 is an exploded perspective view of various componentsshown in FIG. 26;

[0052]FIG. 28 is a perspective view of an alternate embodiment of theinvention adapted to receive an agent cartridge therein;

[0053]FIG. 29 is a sectional side elevation of the proximal portion ofthe device of FIG. 28 with an agent cartridge received therein;

[0054]FIG. 30 corresponds to FIG. 29, but with a proximal end knobdepressed, thereby both locking the agent cartridge into the device andopening the agent cartridge to fluid flow;

[0055]FIG. 31 corresponds to FIG. 30, but with the suture retainer movedproximally to urge agent flow out of the cartridge and through a lumenin the suture retainer; and

[0056]FIG. 32 is a perspective view of an alternate embodiment of theinvention having a plurality of agent delivery holes spaced apart alongthe length of the shaft of the device.

DETAILED DESCRIPTION OF THE DRAWINGS

[0057] In accordance with the present invention there is provided asuture trimmer, the suture trimmer may be utilized by physicians in anyof a variety of surgical procedures where suture loop has been formed intissue to close an incision or wound, or for any other purpose. Aslidable knot may be formed in the suture loop, and the suture trimmermay then be used to engage and advance the knot over a free end of thesuture to close the suture loop. The knot can then be tightened bypulling on the other free end of the suture. The free ends of the suturemay then be trimmed adjacent to the knot by actuating the cutting memberof the suture trimmer.

[0058] Referring now to FIG. 1 there is shown an exemplary embodiment ofa suture trimmer in accordance with the present invention. The suturetrimmer comprises a shaft assembly having a proximal end and distal end,a handle disposed at the proximal end of the shaft, and a first andsecond lever extending from the handle, wherein the first lever andsecond lever are operatively associated with a cutting member and asuture retaining device respectively.

[0059] As shown in FIG. 1, the suture trimmer includes a shaft assembly20. The shaft assembly 20 includes an elongated member 25 having aproximal end 21 and a distal end 22. An opening 23 is formed in theelongated member 25 adjacent to the distal end 22. A fitting 50 may bedisposed adjacent to the distal end 22 of the shaft assembly 20. Thefitting 50 may have a cross-sectional size no greater than that of theelongated member 25. The fitting 50 further includes a groove formedtherein, wherein the groove is adapted to receive at least one length ofsuture therethrough. In a preferred embodiment, the groove is configuredto receive at least two sutures therethrough. The distal face of thefitting 50 is configured to engage a knot formed in a suture loop,thereby enabling the suture trimmer 10 to be utilized as a knot pusherand advance the knot to an incision site. The face of the fitting may beformed having a convex, concave, or flat surface. Alternatively, theface may be formed at an angle relative to an axis extending through theshaft assembly.

[0060] The fitting may be retained within the bore of the elongatedmember through the use of mechanical fasteners or suitable adhesives. Itis further contemplated that the fitting may be formed onto theelongated member utilizing a molding process. Alternatively, the fittingand elongated member may be integrally formed. The fitting is preferablyfabricated of a bio-compatible material, such as metal or plastic.

[0061] The shaft assembly 20 further comprises a cutting member 60 and asuture retaining member 28 disposed within the bore of the elongatedmember. The cutting member 60 and the suture retaining member 28 may beretained within the bore of the elongated member coaxially, though it iscontemplated that they may be retained in other manners, such as,side-by-side or offset. Both the cutting member 60 and the sutureretaining member 28 are disposed for movement within the bore of theelongated member. In various embodiments, cutting member 60 is slidablyor rotatably disposed within elongated member (i.e. shaft) 25, andsuture retaining member 28 is either slidably or rotatable disposedwithin elongated member (i.e. shaft) 25.

[0062] Preferably, the handle of the device includes two levers with thefirst lever being operatively coupled to the suture retainer and thesecond lever being operatively coupled to the cutting member. Forexample, as shown in FIG. 1, a first lever 40 is coupled to sutureretainer 28. Lever 40 is preferably biased so that when an operatorpulls back on lever 40, suture retainer 28 is moved in a proximaldirection. A second lever 45 is coupled to the cutting member 60adjacent to the proximal end. The lever 45 is further configured toengage a biasing member 42 as shown in FIG. 2.

[0063] As shown in FIGS. 3A and 3B, various exemplary embodiments ofcutting member 60 are provided. For example, cutting member 60 maycomprise an elongated member having a proximal end 61 and a distal end62. A cutting edge 63 is formed within the cutting member 60 adjacent tothe distal end 62. As shown in FIG. 3A, a sharpened cutting edge 63 maybe formed to cut suture when cutting member 60 is moved in a proximaldirection. Conversely, as shown in FIG. 3B, the distal end 62 of cuttingmember 60 may be sharpened to act as the cutting edge 63, thus cuttingsuture when cutting member 60 is moved in a distal direction. Thus, aswill be further explained, FIG. 3A illustrates a “pull-to-cut”embodiment of the cutting member of the present invention, whereas FIG.3B illustrates a “push-to-cut” embodiment of the cutting member of thepresent invention.

[0064] The cutting member 60 may be constructed of a bio-compatiblematerial that is capable of having a sufficiently sharp cutting edge 63formed therein. For example, surgical stainless steel may be utilized aswell as titanium. Furthermore, it is contemplated that the cuttingmember may comprise one or more elements coupled together. For examplethe shaft of the cutting member may be constructed of a bio-compatiblematerial such as plastic and the cutting edge 63 may be formed of metalwherein the two pieces are combined to form a single element.

[0065] Referring now to FIG. 4, there is shown the suture retainer inaccordance with the present invention. As shown in FIG. 4, the sutureretainer 28 includes a proximal end 29, a distal end 27, and a sutureprotector 26. In preferred embodiments, suture protector 26 comprises agroove in suture retainer 28 through which a suture can pass when thesuture has entered the device. Thus, the suture passes through groove 26and exits out of the distal end 27 of suture retainer 28. Lever 40 isconnected to the proximal end 29 of the suture retainer 28. This leveris configured to be slidably received within the handle 33 as shown inFIG. 2. The lever 40 is further configured to receive a biasing member47, wherein the biasing member retains suture retainer 28 in a positionwherein the suture retainer projects into the opening 23 formed in theelongated member of the shaft assembly 20.

[0066] The suture retainer may be constructed of a bio-compatiblematerial such as metal or plastic. In a preferred embodiment the sutureretainer is constructed of a bio-compatible plastic. Additionally, thesuture retainer may be constructed of multiple pieces, wherein thesuture retainer and lever are assembled utilizing known methods ofmechanical fastening or through the use of an adhesive. It is furthercontemplated that the suture retainer and lever may be integrallyformed, such as through the use of injection molding.

[0067] Referring now to FIGS. 5 to 7 there is shown the distal endportion of the suture trimmer 10 in accordance with the presentinvention in use. As shown, a suture loop 150 has been formed utilizinga length of suture, wherein the suture loop includes a knot K and twofree ends, S and S′, of suture extending therefrom.

[0068] As illustrated in FIG. 5, the suture retainer 28 has beenwithdrawn (i.e.: moved proximally) into the bore of the shaft assembly20 thereby allowing at least one free end of suture S to be disposedthrough the groove 54 formed in the fitting and groove 19 formed in thewall of the elongated member 25 and to extend out the opening 23 formedin the side of the elongated member 25.

[0069] Referring now to FIG. 6, there is shown the distal tip of thesuture trimmer in accordance with the present invention wherein thesuture retainer 28 has been released, thus allowing the biasing force tomove suture retainer 28 in a distal direction within elongated member25. Specifically, the biasing member is coupled to the proximal end ofthe suture retainer, causing the suture retainer to advance distally andbe received within the bore of the distal end of the shaft assembly. Asshown the suture protector 26 (e.g.: groove) shields the suture S, S′from the edge of the opening 23 formed in the elongated member 25. Thesuture protector 26 ensures that the free end of the suture S cannotcontact the edge of the opening 23 formed in the elongated member 25which may be sharp. If the suture were allowed to contact the edge ofthe opening, a nick or cut may be formed in the suture, this may lead tofailure of the suture before the knot can be advanced and tightened byapplying a force to the free end of the suture. If the suture were tofail the surgeon would be required to place a second suture loopadjacent to the first suture loop and repeat the process of advancingand tightening the knot.

[0070] Referring now to FIG. 7, (which shows the embodiment of cuttingmember 60 as illustrated in FIG. 3A) there is shown a partial view ofthe distal tip of the suture trimmer 10 in accordance with the presentinvention wherein the cutting member 60 has been actuated to cut thesutures after the suture loop has been tightened. Upon actuation, thecutting edge 63 moves in a proximal direction from a shielded positionwithin the distal tip portion of the shaft assembly 20. Specifically,cutting member 60 is moved proximally from the shielded position byapplying a force to the lever 45 (FIG. 1), the lever 45 being coupled tothe proximal end of the cutting member 10. As described above, thecutting member 60 is actuated by pulling back on the lever 45, therebyadvancing the lever towards the proximal end of the suture trimmer 10and compressing a second biasing member disposed within the handle. Thecutting member 60 includes a sharpened cutting edge 63. It is furthercontemplated that the proximal edge 23′ of the opening 23 may also besharpened to assist in cutting the suture between cutting edge 63 andproximal edge 23′. As described above and illustrated in FIG. 7, thecutting member 60 of the suture trimmer 10 moves relative to theelongated member 25 of the shaft assembly 20.

[0071] FIGS. 5 to 7 as described above incorporate the embodiment of thecutting member 60 as shown in FIG. 3A. In this embodiment, the suture ispreferably cut in a “pull-to-cut” approach in which the cutting membermoves in a proximal direction to cut the suture. Alternatively, thepresent invention may instead incorporate the embodiment of the cuttingmember 60 as shown in FIG. 3B in a “push-to-cut” approach. In such a“push-to-cut” approach, the cutting member is advanced distally, withthe suture being cut by the distal end of the cutting member. Furtherexamples of “push-to-cut” approaches are discussed in the variousembodiments which follow herein.

[0072] Referring now to FIG. 8 there is shown an alternative embodimentof a suture trimmer 100 in accordance with the present invention. Asshown in FIG. 8, the suture trimmer 100 comprises a handle 130, anelongated shaft assembly 120, a distal tip fitting 150, a first lever145 and a second lever 141. As shown in FIG. 8, the first lever 145 isconfigured to rotate R about the handle 130 in addition to beingconfigured to be translated along an axis extending through the handle130. The second lever 141 is configured to translate along an axisextending through the handle 130. The functionality of the first andsecond levers will be described in greater detail below with referenceto FIG. 9. It is further contemplated that the first lever 145 may beembodied having a generally cylindrical shape and being disposed aboutthe distal end of the handle. For example, the first lever 145 may be aring.

[0073] Referring now to FIG. 9, there is shown the elongated shaftassembly 120 of the suture trimmer 100. As shown the elongated shaftassembly 120 comprises a hollow elongated member 125 having a proximalend 129 and a distal end 127. An opening 123 is formed in the wall ofthe elongated member 125 adjacent to the distal end 127 thereof. Theopening 123 is further configured to include a sharpened cutting edge,which is formed on the proximal end of the opening 123. The elongatedmember 125 may be constructed of a bio-compatible metal such asstainless steel, titanium or a bio-compatible coated material.Alternatively, the elongated member may be constructed of abio-compatible plastic. The elongated member in a preferred embodimenthas a circular cross-sectional profile, though it is contemplated thatthe elongated member may be constructed having other cross-sectionalprofiles such as square, triangular, or oval.

[0074] A suture retaining member 128 is disposed within the bore of theelongated member 125. The suture retaining member 128 includes anelongated member having a proximal end 137 and a distal end 131. Asuture receiving groove 133 is formed in the distal end of sutureretaining member 128. The suture retaining member 128 is slidably androtatably disposed within the bore of the elongated member 125. Thesuture retaining member 128 may be coaxially disposed within the bore ofthe elongated member 125, or arranged in an offset manner. The proximalend of the suture retaining member is coupled to the first and secondlevers of the suture trimming device, the function of which will bedescribed in detail below.

[0075] The shaft assembly 120 may further include a fitting 150 disposedadjacent to the distal end 127 of the shaft assembly 120. The fitting150 has a cross-sectional size no greater than that of the elongatedmember 125. The fitting 150 further includes a groove 154 formedtherein, wherein the groove 154 is configured to receive at least onelength of suture therethrough. In a preferred embodiment, the groove 154is configured to receive at least two sutures therethrough. The distalface of the fitting 150 is configured to engage a knot formed in asuture loop, thereby enabling the suture trimmer 100 to be utilized as aknot positioner and advance the knot to an incision site. The face ofthe fitting may be formed having a convex, concave, or flat surface.Alternatively, the face may be formed at an angle relative to an axisextending through the shaft assembly.

[0076] As shown in FIG. 9, the proximal end 129 of the shaft assembly120 is connected to a handle 130. Handle 130 comprises a generallycylindrical casing 180 having an open interior chamber 135 and an axialslot 138 (as shown in FIG. 8). A slider assembly 210 is reciprocatablydisposed within the chamber 135, the slider assembly having a proximalend 281 and a distal end 282, the distal end 282 coupled to the proximalend 137 of the suture retainer 128. The slider assembly further includesa first lever 145 and a second lever 141 coupled to the slider assembly210 as shown in FIG. 8. A biasing member 290 is further disposed withinthe chamber 135 wherein the biasing member 290 is disposed in a spaceproximal the proximal end of the slider. The biasing member applies aforce to the slider assembly so that suture retainer 128 will remain ina distally advanced position. It is further contemplated that the suturetrimmer 100 may include more than one biasing member. For example, twobiasing members may be provided in combination and configured to providea progressive spring rate.

[0077] The handle, slider assembly, and levers may be manufactured ofmaterials such as metals or plastics. In a preferred embodiment, thehandle and levers are manufactured of plastic utilizing an injectionmolding process.

[0078] As shown in FIG. 9 the slider assembly 210 is constructed of afirst member 280 having a proximal end 281, a distal end 282, a reduceddiameter portion 284 and an enlarged diameter portion 286 disposedtherebetween. The first member 280 further includes a plurality ofmembers 285 disposed radially about a reduced diameter portion 284 ofthe first member 280. A rotating ring 200 is rotatably disposed aboutthe reduced diameter portion 284. The rotating ring further includes anengaging member 205, wherein the engaging member is configured to engageone of the plurality of members 285 extending radially about the reduceddiameter portion.

[0079] The proximal end 281 is further configured to receive a basingmeans 290. The biasing means may comprise a spring, elastic foam ordevices that have similar mechanical properties.

[0080] The slider assembly and the suture retainer may be constructed asa unitary member or alternatively may be constructed of multiple pieceswhich are then assembled using known manufacturing methods.

[0081] Referring now back to FIG. 8, the first lever 145 is coupled tothe rotating ring 200, wherein a pin (not shown) is utilized to couplethe first lever 145 to the rotating ring 200. By applying a rotationalforce 289 to the rotating ring causes the engaging member 205 to engageat least one of the plurality of members 285, thereby causing the sutureretainer 280 to rotate within the shaft assembly 120. The second lever141, shown in FIG. 8, is coupled to the increased diameter portion 285of the slider assembly 210. The second lever 141 may be connectedthrough the use of a pin (not shown) disposed within the increaseddiameter portion, the pin extending through a groove formed in thehandle as shown in FIG. 8. A force may be applied to the second lever,thereby causing the suture retainer 128 and the second lever to bedisplaced proximally, the suture retainer 128 moving proximally withinthe elongated member 125 of the shaft assembly 120. When such force isapplied, suture retainer 128 will be moved proximally, thus providing anopening for the suture to be received through opening 123 in elongatedmember 125. Thereafter, the force on the second lever can be releasedsuch that suture retainer 128 springs forward in a distal direction,thereby trapping the suture in the device, as explained below.

[0082] Referring now to FIGS. 10 to 13, there is shown a partial view ofthe distal tip of the suture trimmer 100 in accordance with the presentinvention disposed in various states of use, each of which will bedescribed in detail below with reference to the Figures.

[0083] Referring now to FIG. 10, there is shown the distal end of thesuture trimmer 100, wherein the suture retaining member 128 is showndisposed in a distally advanced position. A suture loop has been formedin tissue as shown, the suture loop comprises a knot K formed in a loopof suture, wherein the two free ends S and S′ of the suture extend fromthe knot. In an optional preferred method of use, the tissue is afemoral artery and any of the present suture trimmer embodiments may beused to sever the loose ends of a loop of suture which has been used toclose a hole in the femoral artery. Such femoral artery closure uses maybe preferably conducted in conjunction with agent delivery systemsdescribed herein.

[0084] Referring now to FIG. 11 there is shown the distal tip, whereinthe suture retainer 128 has been retracted (i.e. moved proximally)within the elongated member of the shaft assembly 120 by applying aforce to the second lever 141. The two free ends of the suture asdisposed through a groove 154 formed in the fitting 150 and distal endof the elongated member 125, the two free ends of suture extend throughthe opening 123 formed within the elongated member 125.

[0085] Referring now to FIG. 12, there is shown the distal tip of thesuture trimmer 100 wherein the force applied to the second lever 141(FIG. 8) has been released, thereby allowing the suture retaining member128 to advance distally within the bore of the elongated member 125.Optionally, a rotational force may be applied to the first lever 145(FIG. 8), thereby causing the suture retaining member to rotate withinthe bore of the shaft assembly. By rotating the suture retaining member128, the groove 154 may be effectively closed, thus retaining the twofree ends of the suture within the distal tip of the suture trimmer 100.As can be seen in FIG. 12, the groove 126 in suture retainer 128 can beused to align the two free ends of suture S and S′ with a sharpenedcutting edge 163 formed in the proximal end 123′ of opening 123.Furthermore, optional rotation of the suture retaining member 128 canfurther align the two free ends of the suture with the sharpened cuttingedge 163 formed in the proximal end 123′ of the opening 123.Additionally, as shown, the distal end of fitting 150 can be utilized toadvance the knot K onto the tissue, such that the knot K can betightened by pulling up on one of the free ends of the suture S/S′.

[0086] Referring now to FIG. 13, there is shown the suture loop after anaxial force has been applied to the first lever 145 thereby moving thesuture retaining member 128 proximally within the bore of the elongatedmember thereby advancing the two free ends of the suture into contactwith the sharpened cutting edge 163 formed in the opening 123, such thatthe sharpened cutting edge 163 severs the free ends of the sutureadjacent to the knot K as shown.

[0087] As described above with reference to FIGS. 8 to 13, it shall beunderstood that the cutting member of the suture trimmer 100 remainsstationary in use. Specifically, the elongated member 125 itself acts asthe cutting member in this embodiment of the invention. As shown inFIGS. 10 to 13, a piece of suture to be severed is brought to thecutting edge 163 formed in an edge of opening 123. The suture is severeddue to the interference between the suture, the opening 126 formed inthe suture retaining member 128 and the cutting edge 163.

[0088] Referring now to FIGS. 14 to 18 there is shown an alternativesuture trimmer 300 in accordance with the present invention. As shown inFIG. 14, the suture trimmer 300 comprises a handle portion 330, a shaftassembly 320 and a fitting 350 disposed on the distal end of the shaftassembly. The handle 330, shaft assembly 320 and fitting 350, of thesuture trimmer 300 is similar to each of those described above. Withregard to FIGS. 15 to 18, there is shown the suture trimmer 300 inaccordance with FIG. 14 in use.

[0089] Referring now to FIG. 15 there is shown yet another alternativeembodiment of a suture trimmer in accordance with the present invention.As shown in FIG. 15, the suture trimmer 300 includes a shaft assembly320, a fitting 350 disposed on the distal tip of the shaft assembly andlever 345. The suture trimmer 300 includes a retractable, indicated byreference number 400, elongated member 325 connected to lever 345, thelever connected to a handle 380. In addition to being retractable, theelongated member 325 is further configured to rotate, indicated by thereference number 410, about an axis extending between the distal end andproximal end of the suture trimmer 300.

[0090] Referring now to FIG. 15, there is shown the distal tip of thesuture trimmer 300 wherein the elongated member 325 of the shaftassembly 320 has been retracted, thereby exposing the groove 354 throughwhich the free end(s) of the suture may be disposed as shown.

[0091] Referring now to FIG. 16, there is shown the distal tip, whereinthe force applied to retract the elongated member 325 has been released,thereby allowing the elongated member 325 to advance as shown. Theelongated member 325 is utilized to close the groove 354 when advancedin a distal position as shown in FIG. 16, thereby retaining the freeends of the sutures within the groove 354 as shown. Furthermore, afterallowing the elongated member to advance distally as shown, the distaltip of the suture trimmer may be utilized to advance the knot K andsubstantially close the suture loop.

[0092] Referring now to FIG. 17, there is shown the distal tip of thesuture trimmer 300, wherein the elongated member 325 has been rotatedcounter-clockwise relative to the suture retainer 328. By rotating theelongated member 325 as shown, the free ends of the suture are drawn toa cutting edge 363 formed in the elongated member 325.

[0093] Referring now to FIG. 18, there is shown the suture trimmer 300in accordance with the present invention. As shown in FIG. 18, theelongated member 325 has been retracted relative to the suture retainingmember 328. By retracting the elongated member 325, the free ends of thesuture are brought into contact with the cutting edge 363 formed withinthe elongated member 325, thus trimming the free ends of the sutureclose to the knot K as shown. Although this embodiment of the inventionmoves the elongated member 325 proximally to sever the tissue, it is beunderstood that an alternate embodiment may instead move the sutureretainer distally to achieve the same result.

[0094] Although the suture trimmer 300 is described wherein theelongated body is rotated relative to the suture retaining member 128,it is contemplated that the elongated member may be held stationary andthe suture retaining member may be rotated therein. Still further it iscontemplated that both the elongated member and the suture retainingmember may be rotated respectively.

[0095] Still further, it shall be understood that although theembodiments illustrated herein have been described as utilizing leversto advance/actuate/move various features disposed within or upon thesuture trimmers it shall be understood that other mechanical devices andassemblies may be utilized to perform the same tasks without departingfrom the scope of the present invention.

[0096] In various embodiments of the invention, various suture cuttingtechniques are employed. For example, as shown in FIGS. 19A to 19C, thesuture(s) may be cut between the distal end of the cutting member and ananvil portion of the suture retainer. Alternatively, as shown in FIGS.20A to 20D, the suture(s) may be cut between the distal end of thecutting member and an anvil portion (such as a proximal edge or surface)of the fitting.

[0097]FIGS. 19A to 19C illustrate a “push-to-cut” system in which thecutting member is distally advanced towards a portion of the sutureretainer to sever the suture therebetween. In this embodiment, thesuture retainer is rotated in one direction to receive the suturetherein, and then released so that it rotates in an opposite directionto lock the suture in the device. FIGS. 20A to 20D also illustrate a“push-to-cut” system in which the cutting member is distally advancedtowards a portion of the suture retainer to sever the suturetherebetween. However, in this embodiment, the suture retainer is movedproximally so that the suture can be positioned within the device. Thesuture retainer is then released so that is allowed to distally advanceto lock the suture therein.

[0098] Turning first to FIGS. 19A to 19C, an elongated member (e.g.: ahollow shaft) 25 is provided with a tubular cutting member 60 receivedtherein. A suture retainer 28A is received within the bore of tubularcutting member 60, as shown. Suture retainer 28A is rotatable aroundcentral longitudinal axis A. Suture retainer 28A comprises a groove 26Apassing therethrough. When suture retainer 28A is rotated to the firstposition as shown in FIG. 19A, groove 26A is positioned in alignmentwith both groove 54 in fitting 50 and with opening 23 in elongatedmember 25. A suture S is received therein as shown. (For clarity ofillustration, only a single suture is shown. It is to be understood thata typical use of the present invention will instead have a pair or loopof suture passing therethrough.) After suture S is received in groove26A, suture retainer 28A is then rotated to the second position as shownin FIG. 19B, thereby locking the suture within the device. Thereafter,as shown in FIGS. 19C and 19D, cutting member 60 is distally advanced tosever the suture between an anvil portion 70 of suture retainer 28A. Inexemplary embodiments, anvil portion 70 comprises a flat face of sutureretainer 28A which is disposed perpendicular to the axis of the shaft.

[0099]FIGS. 20A to 20D show an alternate embodiment in which a slidingsuture retainer 28B is used to trap the suture in the device. Anelongated member (e.g.: a hollow shaft) 25 is provided with a tubularcutting member 60 received therein. Suture retainer 28B is receivedwithin tubular cutting member 60. Suture retainer 28B is slidable withinelongated member 25. Suture retainer 28B further includes a groove 26B(shown in dotted lines in FIG. 20B) passing therethrough. When sutureretainer 28B is retracted (moved proximally) to the position shown inFIG. 20A, a suture S is then received therein as shown. (For clarity ofillustration, only a single suture is shown. It is to be understood thata typical use of the present invention will instead have a pair or loopof suture passing therethrough.) After suture S is received within thedevice, suture retainer 28B is then advanced distally to the positionshown in FIG. 20B, thereby locking the suture within the device.Thereafter, as shown in FIG. 20C, cutting member 60 is distally advancedto sever the suture between the distal end 62 of the cutting member 60and a proximal edge 52 or other flat face or suitable anvil portion(FIG. 20D) of fitting 50.

[0100] In various optional embodiments of the present invention, thepresent invention includes systems that dispense an agent at a locationadjacent to where the suture is severed, such as the distal end of thedevice. In preferred embodiments, the agent may comprise ananti-infective agent, a coagulant, or a tissue glue, but the presentinvention is not so limited.

[0101] In accordance with the present invention, a cavity may beprovided in the suture trimmer which is adapted to receive the agenttherein. As will be shown, such cavity may comprise a tube or lumenpassing through (or simply adjacent to) the suture retainer. Inaddition, the cavity adapted to receive the agent may comprise adelivery tube passing through a portion of the handle of the device. Inalternative embodiments, the cavity may also simply comprise an agentstorage chamber in the handle of the device. In further alternativeembodiments, the cavity may also comprise a removable agent deliverycartridge which is inserted into the device.

[0102] Referring first to FIG. 21, a schematic illustration of a firstembodiment of the invention which is configured to dispense an agent isprovided, as follows. Suture trimmer 200 includes an elongated member225 and a handle 230. Within elongated member 225 is disposed a tubularcutting member 260 having a distal cutting end 263. A fitting 250 isattached to the distal end of elongated member 225. Within cuttingmember 260 is disposed a suture retainer 228. In different embodiments,suture retainer 228 may either be rotated or be distally advanced by theoperation of lever 240 to lock a suture into the device (similar to theabove described operation of suture retainer 28). It is to be understoodthat elongated member 225, handle 230, lever 240, cutting member 260,suture retainer 228 operate in the same ways as the various abovedescribed embodiments of the elongated member, handle, lever, cuttingmember, suture retainer, etc. Moreover, for clarity of illustration,internal biasing devices and mechanical actuators have been omitted fromFIGS. 21 to 24. Such internal biasing devices and actuators are providedand operate in the same manner as was described above.

[0103]FIG. 21 illustrates an embodiment of an agent delivery system, asfollows. A tube 300 is disposed within suture retainer 228. Tube 300 hasan open distal end 302 through which the agent is dispensed. Thus, theagent is dispensed at a location which is close to, or adjacent to, orsimply near, the location where the suture is severed by the cuttingmember. In various embodiments of the invention, suture retainer 228 mayeither be advanced distally/retracted proximally or be rotated byactuating lever 240 on handle 230 using various mechanisms describedherein.

[0104] A portion of tube 300 which passes through handle 230 includes anagent delivery tube 304. An inlet port 306 is provided in handle 230.Inlet port 306 may include a one-way check valve or luer connector 308.Thus, an operator is able to inject agent into agent delivery tube 304by way of a syringe 310 (or other suitable delivery tube). In thisembodiment, the operator is free to choose which agent is used (thusselecting from a variety of different agents pre-stored in varioussyringes or cartridges).

[0105] In the various embodiments where suture retainer is slidablymoved or rotated within the device, tube 300 may remain stationary withsuture retainer 228 sliding back and forth or rotating thereover.Alternatively, tube 300 may be replaced with a lumen passing through thesuture retainer.

[0106] FIGS. 22 to 23B illustrate an embodiment of the invention inwhich the agent is pre-stored in a chamber in the handle of the device.In this embodiment, the cutting member is preferably actuated at thesame time that the agent is dispensed. Specifically, the agent ispre-stored in a chamber 320. A lumen 301 passes through suture retainer228. Suture retainer 228 is received within cutting member 260. As shownschematically in FIGS. 23A and 23B, a plunger 325 is pushed distally indirection D thereby simultaneously advancing cutting member 260 whilesqueezing agent from chamber 320, out through the distal end of lumen301. Thus, the agent may be dispensed at the location where the sutureis severed at the same time as the cutting member severs the suture.

[0107]FIG. 24 is a schematic view corresponding to FIGS. 22 to 23B, butinstead showing a removable cartridge 340 pre-filled with a suitableagent. When cartridge 340 is inserted into suture trimmer 200, plunger325 is positioned to compress cartridge 340, for example, by movingcartridge wall 342 in distal direction D. Cartridge 340 may furthercomprises a removable or tear-away portion 344 which, when ruptured orremoved, permits the agent to be squeezed into lumen 301 as cartridge340 is compressed.

[0108] It is to be understood that FIGS. 23A to 24 are schematicdrawings, and are thus only meant only to illustrate the operatingprinciples of the invention. Actual internal operating mechanisms mayvary from those illustrated herein. As such, different internalmechanisms which achieve the same results are contemplated, all keepingwithin the scope of the present invention. Also, additional componentsmay be included. For example, additional actuators and levers (notshown) may be included to control the movement of the suture retainer,cutting member and plunger, or to puncture or otherwise open a cartridgeto release an agent.

[0109]FIG. 25 shows an embodiment of the cutting member in which thecutting member further includes force absorbing features 65. Inparticular, the force absorbing features comprise a series of laser cutholes near the proximal end of cutting member 60. Holes 65 areconfigured to give cutting member 60 the ability to deform slightlyalong its length. Therefore, when distal cutting edge 63 severs thesuture (against either the suture retainer or the fitting) the portionof cutting member 60 that includes holes 65 will absorb some of thecutting force, thereby providing overall smoother device operation.

[0110]FIG. 26 shows an embodiment of the invention in which chamber 320is annular in shape. Plunger 325 is also annular in shape. Plunger 325is pushed into chamber 320 by an annular shaped bushing 360. In thisparticular embodiment, bushing 360 is moved distally by depressing lever45. Alternative configurations and actuation mechanisms are possible,all keeping within the scope of the present invention. For example,suture trimmer 228 may either be a rotating or sliding suture retainingmechanism as described above.

[0111] As further shown in FIG. 26, inlet port 306 may be positionedsuch that it enters directly into chamber 320 (thus avoiding long fluidtubes or conduits within the handle of the device).

[0112]FIG. 27 shows further details and shapes of the components shownin FIG. 26. In this particular embodiment, the bushing 360, plunger 325and chamber 320 are shown in an exploded view. Actuating lever 45 pushesbushing 360 which in turn pushes plunger 325 into cavity 320. As wasshown in FIG. 26, agent squeezed out of cavity 320 then passes throughan opening in cutting member 260 and out through a lumen 301 in sutureretainer 228. As can also be seen, cutting member 260 and plunger 325may be actuated simultaneously when bushing 360 is moved distally byactuating lever 45. Moreover, as shown in FIG. 27, lever 45 may bedimensioned so that it does not contact suture retainer 228 and thusmoves independently of suture retainer 228. Also, bushing 360 andplunger 325 may also be dimensioned to slide over suture retainer 228 sothat bushing 360/plunger 325 move independently of suture retainer 228.

[0113] FIGS. 28 to 31 show an alternate embodiment of the inventionadapted to receive an agent cartridge into a proximal portion of thehandle of the device. In particular, suture trimmer 500 is adapted toreceive a cartridge 510 therein. In an exemplary embodiment, cartridge510 is a Carpuject™ cartridge, made by Abbott Laboratories of AbbottPark, Ill. However, any suitable cartridge may also be used within thescope of the present invention. As shown in FIG. 29, cartridge 510 isfirst placed within a handle portion of suture trimmer 500. Cartridge510 includes a puncturable seal 511 at its distal end and a slidableplug 512 at its proximal end. Plug 512 moves distally into tubing 515(toward seal 511) when pressed. After an operator has selected thecartridge 510 and placed the cartridge in the body of the handle of thedevice (as shown in FIG. 29), end knob 514 is then depressed. Bydepressing end knob 514, cartridge 510 is then moved to the position asshown in FIG. 30 where cartridge 510 is moved proximally so that needleend 513 penetrates into cartridge 510. In optional preferred aspects,needle end 513 is simply connected to lumen or tube 302 which passesthrough suture retainer 228. Thus, cartridge 510 is now locked inposition within the device and a flow path for the agent from cartridge510 through suture retainer 228 is thereby opened. Thereafter, as shownin FIG. 31, suture retainer 228 is moved proximally (for example, bypulling back on handle 540 in FIG. 28). As can be seen, end knob 514will keep plug 512 stationary while the outer tubing 515 (which formsthe cartridge) will be pushed proximally such that its proximal end 516is received into annular void 518. Thus, when suture retainer 228 ismoved proximally, suture the agent in cartridge is forced out of thedistal end of lumen 302 through suture retainer 228. The agent isdispensed at a location near where the suture is being cut. It is to beunderstood that the above description is only exemplary and thatalternate embodiments in which different components of the inventionmove to receive a cartridge and to dispense agent from the cartridge arepossible within the scope of the invention.

[0114]FIG. 32 illustrates an alternate embodiment of the invention inwhich shaft 25 has a plurality of agent delivery holes 600 disposedalong the length of shaft 25. Agent delivery holes 600 are configured todispense an agent along the path (i.e.: tissue tract) in which thesuture trimmer 10 enters the patient's tissues. Any of a variety ofinternal mechanisms can be provided to dispense agent directly throughholes 600 in shaft 25, all keeping within the scope of the presentinvention. Since a suture trimmer is typically the last surgicalinstrument which is inserted in the patient, the present optional suturetrimmer embodiment that is configured to dispense an agent along thepath of the incision to the operative site is especially beneficialsince anti-infective agents or coagulants or other agents may bedispensed along the path of the incision. In one optional embodiment,the series of agent delivery holes 600 may have varying diameters. Theexemplary embodiment shown in FIG. 32 shows holes 600 that increase insize in the distal direction. Thus, more agent may be delivered at thedistal end of the device (near where the suture is severed).

[0115] Although the present invention has been described in considerabledetail with reference to certain preferred embodiments, it iscontemplated that one skilled in the art may make modifications to thedevice herein without departing from the scope of the invention.Therefore, the scope of the appended claims should not be consideredlimited to the embodiments described herein.

What is claimed is:
 1. A suture trimmer, comprising: a shaft having a proximal end and a distal end and an axis therebetween, the shaft having a groove formed in the side thereof, the groove in communication with an opening formed in the side of the shaft, the opening disposed proximal the distal end; a cutting member slidably disposed within the shaft; and a suture retainer movably disposed within the shaft.
 2. The suture trimmer of claim 1, wherein the suture retainer is slidably disposed within the shaft.
 3. The suture trimmer of claim 1, wherein the suture retainer is rotatably disposed within the shaft.
 4. The suture trimmer according to claim 1, wherein the cutting member includes force absorbing features.
 5. The suture trimmer according to claim 1, wherein the cutting member is moved distally relative to the shaft to sever the suture.
 6. The suture trimmer according to claim 1, wherein the cutting member is moved proximally relative to the shaft to sever the suture.
 7. The suture trimmer according to claim 1, wherein the cutting member is rotated relative to the shaft to sever the suture.
 8. The suture trimmer according to claim 1, wherein the distal end of the cutting member is movable toward an anvil portion of the suture retainer.
 9. The suture trimmer according to claim 8, wherein the anvil portion of the suture retainer comprises a flat face of the suture retainer disposed perpendicular to the axis of the shaft.
 10. The suture trimmer according to claim 1, wherein the distal end of the cutting member is movable toward a fitting disposed in the distal end of the shaft.
 11. The suture trimmer according to claim 10, wherein the fitting includes a flat face disposed perpendicular to the axis of the shaft.
 12. The suture trimmer of claim 1, further comprising: a cavity in the suture trimmer adapted to receive an agent therein, wherein the suture trimmer is adapted to dispense the agent near the distal end of the shaft.
 13. The suture trimmer of claim 12, wherein the cavity comprises a lumen passing through the suture retainer.
 14. The suture trimmer of claim 12, further comprising: a handle at the proximal end of the shaft, wherein the cavity comprises an agent delivery tube passing through the handle.
 15. The suture trimmer of claim 12, further comprising: a handle at the proximal end of the shaft, wherein the cavity comprises a chamber in the handle.
 16. The suture trimmer of claim 15, further comprising: a removable cartridge received into the chamber in the suture trimmer, wherein an agent is stored within the cartridge.
 17. The suture trimmer of claim 16, wherein the removable cartridge includes a moveable wall which is adapted to be pushed into the cartridge by the action of a plunger.
 18. The suture trimmer of claim 12, further comprising: a handle at the proximal end of the shaft, wherein the cavity comprises both a chamber in the handle and a lumen passing through the suture retainer, and wherein the proximal end of the lumen is in fluid communication with the chamber and a distal end of the lumen opens at the distal end of the suture retainer.
 19. The suture trimmer of claim 18, further comprising: a plunger positioned to be received into the chamber, wherein the plunger pushes the agent out of the chamber, through the lumen in the suture retainer and out of the distal end of the suture retainer when the plunger is advanced into the chamber.
 20. The suture trimmer of claim 19, wherein both the cutting member and the plunger are activated simultaneously by the same actuator.
 21. The suture trimmer of claim 12, wherein the handle of the suture trimmer is configured to receive a removable cartridge therein, and wherein movement of an actuator on the suture trimmer opens a flow path into the cartridge.
 22. The suture trimmer of claim 12, wherein the handle of the suture trimmer is configured to receive a removable cartridge therein, and wherein movement of an actuator on the suture trimmer urges agent flow out of the cartridge.
 23. The suture trimmer of claim 12, wherein the handle of the suture trimmer is configured to receive a removable cartridge therein, and wherein the suture trimmer is configured such that movement of an actuator on the suture trimmer decreases the cartridge volume while a slidable plug in the cartridge is held stationary by the handle.
 24. A suture trimmer comprising: a shaft having a groove formed in the side thereof, the groove in communication with an opening formed in the side of the shaft; a cutting member movably disposed within the shaft; a suture retainer movably disposed within the shaft; and a cavity in the suture trimmer adapted to receive an agent therein, wherein the suture trimmer is adapted to dispense the agent.
 25. The suture trimmer of claim 24, wherein the suture retainer is slidably disposed within the shaft.
 26. The suture trimmer of claim 24, wherein the suture retainer is rotatably disposed within the shaft.
 27. The suture trimmer according to claim 24, wherein the cutting member is moved distally relative to the shaft to sever the suture.
 28. The suture trimmer according to claim 24, wherein the cutting member is moved proximally relative to the shaft to sever the suture.
 29. The suture trimmer according to claim 24, wherein the distal end of the cutting member is movable toward an anvil portion of the suture retainer.
 30. The suture trimmer according to claim 24, wherein the cutting member is movable toward a fitting disposed in the distal end of the shaft.
 31. A method for trimming suture, comprising: disposing a free end of suture through a groove and an opening formed in a distal end of a suture trimmer; and actuating a cutting member within the suture trimmer, the cutting member configured to sever the suture disposed in the opening.
 32. The method according to claim 31, wherein disposing the free end of the suture through a groove and opening comprises moving the suture retainer in a proximal direction within the suture trimmer.
 33. The method according to claim 31, wherein disposing the free end of the suture through the groove and the opening in the in the distal end of the suture trimmer comprises rotating a suture retainer within the suture trimmer.
 34. The method of claim 31, further comprising: cutting the suture between the distal end of the cutting member and an anvil portion of the suture retainer.
 35. The method of claim 34, wherein the suture trimmer further comprises a fitting at a distal end of the shaft, further comprising: cutting the suture between the distal end of the cutting member and a proximal edge of the fitting.
 36. The method of claim 31, further comprising: dispensing an agent at a location adjacent to where the suture is severed.
 37. The method of claim 36, wherein the agent is dispensed through a lumen passing through the suture retainer.
 38. The method of claim 36, wherein the agent is pre-stored in a chamber in a handle at the proximal end of the shaft, the chamber being in fluid communication with the lumen passing through the suture retainer.
 39. The method of claim 36, wherein the agent passes through an agent delivery tube in a handle at the proximal end of the shaft, the agent delivery tube being in fluid communication with the lumen passing through the suture retainer.
 40. The method of claim 39, further comprising: injecting the agent into the chamber through a one-way check valve.
 41. The method of claim 39, further comprising: injecting the agent into the chamber through a luer connector.
 42. The method of claim 38, further comprising: advancing a plunger into the chamber to push the agent out of the chamber in the handle and through the lumen in the suture retainer and out of the distal end of the suture retainer.
 43. The method of claim 42, wherein the plunger and the cutting member are actuated simultaneously.
 44. A method for performing a medical procedure within a tissue tract adjacent a patient's femoral artery, the method comprising: placing a loop of suture through a wall of the femoral artery; cutting the suture at a location within the tissue tract; and delivering an agent to the tissue tract in the vicinity of the loop of suture.
 45. The method of claim 44, further comprising: providing a suture trimmer that performs the cutting of the suture and delivery of the agent.
 46. The method of claim 45, wherein the suture trimmer includes a shaft, a suture retainer movably disposed within the shaft, and a cutting member slidably disposed within the shaft. 